Little is known about the optimal way to manage 'true' erythropoietin resistance or erythropoietin hypo-responsiveness. Traditionally, nephrologists have overcome erythropoietin resistance by prescribing large or escalating Eprex® doses over prolonged periods of time. There is minimal data that suggests the optimal way to manage these patients. There are no published protocols that have studied systematic increases or decreases in Eprex® in such patients. Furthermore, there are few studies on the safety of the use of high dose Eprex® over prolonged periods of time. It is not known whether a dose ceiling beyond which Eprex® is no longer pharmacologically effective exists in patients with 'true' Eprex® resistance. Studies into the cost effectiveness of high dose Eprex® therapy in Eprex® resistant patients are limited.